Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...
Do you routinely use mannitol to prevent cisplatin-induced nephrotoxicity?
Having treated thousands of patients over the past several decades, we NEVER use mannitol nor do we find any logic for its administration in patients getting appropriate pre-chemo and post cisplatin saline hydration.
Would you offer RT alone to an elderly woman with squamous cell carcinoma in-situ of the vulva, distal vagina, and periurethral area?
I have had such a patient; multiply recurrent over a relatively large field such as this case. I gave her RT alone (45-50.4Gy) to central structures with large margin (no nodal treatment) and she was recurrence free for 5 years (last time I saw her).
Would you consider HIPEC in a known BRCA+ IIIC ovarian cancer patient undergoing interval debulking surgery if the patient is known to desire PARPi maintenance following completion of chemotherapy?
Yes. There is currently no known stratification for BRCA patients undergoing HIPEC. OVHIPEC1 demonstrated an 11 mo. OS benefit in stage III patients undergoing interval CRS with HIPEC. In this study, patients did not undergo maintenance PARPi. BRCA patients have previously reported to have better ou...
How do you manage patients with chemotherapy-induced paronychia?
I manage patients with chemotherapy-induced paronychia with a few tricks: First, ensure that there is no infection (active drainage, especially purulent) is more indicative of infection, as well as appropriate hygiene. Topical steroids and soothing soaks (such as Domeboro or diluted distilled white ...
Would you consider a PARP inhibitor in the treatment of a PARP inhibitor naïve platinum resistant recurrent ovarian cancer with LOH/HRD?
These are challenging scenarios and with increasing PARP use in the upfront setting, especially (likely) in the LOH/HRD patients I suspect this clinical scenario may become less frequent in the future. For now, it's appealing to suggest that LOH/HRD scores as a biomarker can be examined in a vacuum ...
How would you manage mild SUV uptake at a 3 month PET/CT scan post chemoRT scan for a SCC of the cervix?
Typically at our institution, we would decide the next steps based on her exam findings. If there is concern for residual disease, we would either biopsy or see the patient back in a short period of time for a repeat exam. If there is nothing convincing to biopsy, we would likely repeat the PET/CT i...
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
In my experience, tumor boards serve 2 purposes. Firstly, they are designed to bring multiple specialists and cancer providers together in real-time to facilitate patient care. Secondly, they help educate the various disciplines based on a robust interaction. Virtual conferences are complicated by d...
How does your approach to low-risk gestational trophoblastic neoplasia differ for patients whose hCG levels plateau following initial single agent systemic therapy vs those who have a good initial response and then plateau?
For patients with low risk GTN whose hCG values plateau over a two-week interval, concerns arise about chemoresistance. Unfortunately, there is no consensus or clear guideline in terms of determining chemoresistance and when to switch therapy. I don't approach the two clinical scenarios presented he...
How do you boost patients with IVA cervical cancer who present with a large fistula that worsens during chemoradiation?
Preferred is interstitial brachy with our dose of 5.5 to 6 Gy x 5 in BID fractionation. Either MRI pre brachy with CT-based planning with applicator or MRI-based planning if can use hybrid applicator.